Background: This paper describes the background, aim and study design for the Swedish SELMA study that aimed to investigate the importance of early life exposure during pregnancy and infancy to environmental factors with a major focus on endocrine disrupting chemicals for multiple chronic diseases/disorders in offspring.

Methods: The cohort was established by recruiting women in the 10th week of pregnancy. Blood and urine from the pregnant women and the child and air and dust from home environment from pregnancy and infancy period have been collected. Questionnaires were used to collect information on life styles, socio-economic status, living conditions, diet and medical history.

Results: Of the 8394 reported pregnant women, 6658 were invited to participate in the study. Among the invited women, 2582 (39%) agreed to participate. Of the 4076 (61%) non-participants, 2091 women were invited to a non-respondent questionnaire in order to examine possible selection bias. We found a self-selection bias in the established cohort when compared with the non-participant group, e.g. participating families did smoke less (14% vs. 19%), had more frequent asthma and allergy symptoms in the family (58% vs. 38%), as well as higher education among the mothers (51% vs. 36%) and more often lived in single-family houses (67% vs. 60%).

Conclusions: These findings indicate that the participating families do not fully represent the study population and thus, the exposure in this population. However, there is no obvious reason that this selection bias will have an impact on identification of environmental risk factors.

Cross-sectional studies have produced clear inverted U-shaped curves between injury mortality and economic development; yet, this does not mean that single countries will necessarily follow similar curves as they grow richer over time. This study was conducted to examine whether previous cross-sectional findings can be verified using a longitudinal approach. Data for both injury mortality and gross domestic product (GDP) per capita were obtained from an official health database for the member countries of the Organization for Economic Cooperation and Development (OECD) for the period of 1960–1999. Regression models were then used to examine the longitudinal relationship between these two variables. Substantial improvements in injury mortality were observed in all income categories in the selected countries. For higher and middle high-income countries, injury mortality rates (all causes) increased until 1972, peaking in 1972 and then declining. For industrialized countries with relatively low GDP, injury mortality rates increased until 1977 and then declined. Using cubic regression lines for injury mortality rates, for all income categories, injury mortality rates increased up to a GDP per capita of $3000–$4000, then decreased significantly. The rising trends of suicide and homicide rates were observed until countries attained a GDP per capita of around $13,000–$14,000 for all income categories. It is noteworthy that compared to the intentional injury categories, mortality due to road traffic accidents and injuries from falls declined earlier on in the economic development process. Longitudinal analysis among high-income countries confirms earlier cross-sectional findings; that is, most injury categories seem to follow inverted U-shaped trend lines, with declining trends after peaking at various stages of temporal and economical development. A comparison between time and economy suggests that differences in peaking time between countries for the same injury category is partly a reflection of temporal differences in economic development.

Risk management is a comparatively new, and most definitely complex, research field, combining knowledge from several other disciplines such as medicine, engineering, economics and psychology, to name a few. Consequently, risk management is important in a variety of subjects and disciplines, clearly illustrated in this festschrift. Professor Ragnar Andersson has played an important roll in not only promoting the importance of risk management and injury prevention, but also developing a deeper understanding of the field through always actively choosing a broad, multi-disciplinary perspective. In other words, he has always chosen “via spatiosa”. Or in Swedish, “den breda vägen”.

Fall-related injuries have been a cause of worry during the end of the 20th century with increasing trends among the elderly.

Method

Using data from the Swedish National Patient Register (NPR) based on hospital admissions, this study explores the trends in fall-related fractures between 1998 and 2010.

Results

The data shows a decreasing trend in fall-related fractures in all age- and sex-specific groups apart from men 80 years and above. While hip fracture incidence rates decreased in all age- and sex-specific groups, both central fractures and upper extremity fractures have increased in all age- and sex-specific groups apart from women 65–79 years. Lower extremity fractures have increased in the older age groups and decreased in the younger. Discussion: The differences found between the groups of fractures and by age- and sex-specific groups indicate a possible transition where more serious fractures are decreasing while less serious fractures increase among hospitalized cases.

Summary

Perhaps due to a focus on hip fracture prevention, this study shows that while the incidence rate of hospitalized hip fractures has decreased, other fall-related hospitalized fractures have increased.

Impact on industry

Potentially, this could be indicative of a healthier younger elderly, coupled with a frailer older elderly requiring more comprehensive healthcare also for less serious injuries. Further research is needed to confirm our results.

Previous studies have indicated increasing trends of hospitalized fall-related injuries amongst elderly. Whether this is true also in Sweden is unknown though it is important to study considering the potential societal impact. Data were obtained regarding hospitalized injuries with falls as external cause among those aged 65 years and above with information on injury type, gender and age, on a yearly basis, from 2001 to 2010. Age- and sex-specific incidence rates were calculated (per 100,000 population) for all fall-related injuries, and for each injury type and trend lines were drawn. Linear regression analyses and percentage change were calculated for the types of fall-related injuries. A decreasing incidence was observed in the younger age groups (65-79 years) with greater decreases amongst women (women: -14.6%, men 65-79 years: -10.5%). However, increasing rates were observed in the older age group (80 years and above), with greater increases amongst men (women: 4.3%, men: 11.4%). Superficial injuries showed greater increases than fractures amongst those aged 80 years and above. This study indicates that older elderly in Sweden are increasingly being hospitalized for less serious injuries. This changing injury panorama is important to include in the future planning of both health care and fall-related prevention.

Background Previous trend studies have shown large increases in hip fracture incidence rates among the elderly. International research, however, suggests a levelling off, or decline, of hip fracture incidence rates, although for Sweden this remains to be studied.

Methods Data were obtained regarding hip fractures among individuals 65 years and above from 1987 to 2009. Analysis was performed in three steps. First, age- and sex-specific trends in hip fracture rates per 100 000 and the mean age when sustaining a hip fracture were analysed. Secondly, the annual percentage change was used to compare time periods that helped to quantify changes in secular trends. Finally, linear and Poisson regression models were used to examine the trend data and observed rates.

Results The absolute number of hip fractures among the elderly in Sweden has largely remained constant between 1987 and 2009, while incidence rates have decreased for all age- and sex-specific groups, with the largest changes in the younger age groups and among women. The mean age of sustaining a hip fracture has increased for both men and women.

Conclusions This study supports other international studies in showing a decrease in hip fracture incidence rates among the elderly, especially since the mid-1990s.